Friday, 2 October 2015

Melanoma

MELANOMA


Most agreessive malignant cutaneous tumor((epidermal melanocytes))

COMMON:::
MC in whites>blacks
MC type in dark skin-acral lentiginous
MC type-superficial spreading
LESS common-lentigo malignan/hutchinson melanotic freckle
LEAST common-acral lentiginous type

SEX:::
females-lentigomaligna
males-nodular

AGE:
old age-lentigo maligna(indolent lesion on face)
young age-nodular


SITES:::
head and neck-superficial spreading
mucosa-nodular
face-lentigo maligna
palms & soles-acral lentiginous
GIT-amelanotic melanoma

RISK FACTORS:::
UVL,albinism,naevus,xeroderma pigmentosa,h/o skin cancer

SUNEXPOSURE:::
Related-superficial spreading,lentigo maligna
unrelated-acral lentiginous
MALIGNANT:::
most-nodular
least-lentigomaligna

GROWTH:::
horizintal/radial-superficial spreading,lentigo maligna,acral lentigenous
vertical /deep spreading-nodular


CLINICAL FEATURES::: ABCDE
A-asymmetry
B-border irregularity
C-colour variation
D-diameter>6mm
E-elevation


☆☆☆NOTE☆☆☆
Earliear SUBUNGUAL MELANOMA was thought to be a type of acral lentigenous but now it is considered as superficial spreading type....it involves nail plate matrix(NOT NAL PLATE) called as HUTCHINSON SIGN
☀MC spread-lymphatics
☀MC site of metastasis-liver


☀PROGNOSIS:::CLARKES & BRESLOW
Single most imp prognostic factor-depth of invasion
BEST-lentigo maligna melanoma
BETER-superficial spreading
POOREST-nodular
WORST-amelanotic melanoma>>>>acral lentigenous


TUMOR MARKERS::
MELANIN-A
S 100
VIMENTIN
HMB 45
LDH
NOTE:: NEGATIVE FOR CYTOKERATIN 20

INVESTIGATION:::
excision biopsy
FNAC
U/S abdomen
chest X-ray
SLNB

RX:::
primary-wide exicision
LN 2°-regional block dissection
recurrent melanoma-MELPHALAN

MOST AGRESSIVE-nodular melanoma✔
MOST DANGEROUS-amelanotic melanoma

Credits :Dr.@nu

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